Acculturation and changes in health among Navajo boarding school students

This paper describes the relationship between cultural background and illness experience among Navajo students during their first year at a reservation boarding school. Sixty Navajo children were enrolled in a 9-month, prospective study in which three descriptors of change in health status were assessed: (a) number of dormitory aide contacts initiated by the child for an illness complaint; (b) number of clinic visits for an illness judged by the aide to require medical attention; and (c) number of psychosocial problems referred to the clinic or to the boarding school administration. Two measures of cultural background were developed to estimate the location of each child along a continuum of acculturation, ranging from a traditional Navajo cultural orientation to full assimilation into modern Anglo-American society. First, the home communities for all children in the study population were ranked by eleven Navajo informants on an equal-interval scale reflecting community differences in cultural identity. Second, a questionnaire assessing acculturative dimensions of family life style was administered to each child by a Navajo assistant. In addition, each student was assigned a score for cultural incongruity, defined as the degree of absolute difference between community and family measures of cultural background. The reliability and validity of each index of acculturation were confirmed using a variety of psychometric approaches. Controlling for the confounding effects of age, sex and family size, a significant positive association was found between the number of clinic visits and the degree of cultural incongruity. Boarding school students from families and communities which conflicted in cultural orientation experienced higher rates of clinic visits for illnesses requiring medical attention. This result is discussed in the context of current understandings of the epidemiological consequences of cultural change.